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Peri-Procedural Blood Pressure Changes and Their Relationship with MACE in Patients Undergoing Percutaneous Coronary
Susan Labib1, Hussein Heshmat Kassem1, Hossam Kandil1
1Department of Cardiology, Cairo University, Cairo, Egypt.
Insights
Significant blood pressure changes during percutaneous coronary intervention (PCI) predict major adverse cardiovascular events (MACE). Large systolic blood pressure differences (>20 mmHg) and diastolic blood pressure differences (>10 mmHg) correlate with increased cardiac mortality.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Outcomes
Background:
- Investigating peri-procedural blood pressure (BP) changes in patients undergoing percutaneous coronary intervention (PCI).
- Correlating BP fluctuations with major adverse cardiovascular events (MACE) as outcome predictors.
- Analyzing patients with acute coronary syndrome or scheduled for elective PCI.
Purpose of the Study:
- To determine the relationship between peri-procedural blood pressure variations and MACE in PCI patients.
- To identify specific BP difference thresholds indicative of increased cardiovascular risk.
- To evaluate BP changes as a predictor of cardiac mortality and other adverse events post-PCI.
Main Methods:
- Recruited 204 patients undergoing PCI, measuring resting BP thrice: pre-procedure, in-lab, and post-recovery.
- Categorized patients based on peri-procedural systolic BP (SBP) difference (>20 mmHg vs ≤20 mmHg) and diastolic BP (DBP) difference (>10 mmHg vs ≤10 mmHg).
- Analyzed primary endpoints of MACE (mortality, MI, stroke) using Mann-Whitney U and Chi-square tests (p<0.005).
Main Results:
- Cardiac mortality was the sole MACE observed.
- Significantly higher cardiac mortality in the large SBP-difference group (10.6%) compared to the small-difference group (0.6%, p=0.003).
- Elevated cardiac mortality also noted in the large DBP-difference group (7.7%) versus the small-difference group (0.7%, p=0.013).
Conclusions:
- Peri-procedural systolic BP differences exceeding 20 mmHg correlate with MACE in PCI patients.
- Peri-procedural diastolic BP differences exceeding 10 mmHg are associated with MACE.
- These BP variations serve as significant predictors of adverse outcomes following PCI.
Background:
Peri-procedural blood-pressure (BP) changes were investigated and correlated to Major adverse cardiovascular events (MACE) as predictor of outcome for patients undergoing percutaneous coronary intervention (PCI); whether acute coronary syndrome (Unstable angina, or MI; STEMI or NSTEMI) or scheduled for elective PCI.
Methods:
Resting BP in the 204 recruited patients undergoing PCI throughout 2018 was measured thrice - in the ward before transferring to the cardiac catheterization lab (cath lab), in the cath lab, and after transfer to the recovery room. Patients were categorized based on their systolic and diastolic BP peri-procedural difference as systolic (SBP): with a large difference (>20 mmHg, n=47), with a small difference (≤20 mmHg, n=157) (shock patients excluded); diastolic (DBP): with a large difference (>10 mmHg, n=65), and with a small difference (≤10 mmHg, n=139). The primary end-points were MACE including all-cause mortality, non-fatal myocardial infarction, and stroke during the hospital stay. The Mann-Whitney U and Chi-square tests were used to analyze the data accordingly (p<0.005).
Results:
Within the category of MACE, cardiac mortality was the only adverse cardiac event encountered in the study sample. Cardiac mortality was significantly higher in both the large SBP-difference group versus the other group (10.6% vs 0.6%, p=0.003) and the large DBP-difference group versus the small-difference group (7.7% vs 0.7%, p=0.013).
Conclusion:
Peri-procedural systolic and diastolic BP differences, greater than 20 mmHg and 10 mmHg, respectively, correlated with MACE in all patients undergoing PCI.
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